Transcript Findings of the Comprehensive Cancer Needs Assessment

Findings of the
Comprehensive Cancer
Needs Assessment
Piedmont Health District
Presented by: Justine A. Young, RN, BSN, MBA
TOBACCO INDEMNIFICATION AND COMMUNITY
REVITALIZATION COMMISSION GRANT
Saving Lives and Reducing Suffering and Death from
Cancer in Virginia
Goal 1: Perform a comprehensive cancer
needs assessment in four Health Districts
located within the Southside/Southwest
Tobacco County area.
Goal 2: Mobilize resources into the
Southside and Southwest Counties for
which comprehensive cancer needs
assessments were performed to address
identified needs.
TOBACCO INDEMNIFICATION AND
COMMUNITY REVITALIZATION COMMISSION
GRANT
Saving Lives and Reducing Suffering and
Death from Cancer in Virginia
Comprehensive Cancer Needs Assessment
Guided by a broad based Advisory Committee
Parameters Assessed:
Cancer burden
Cancer care services – detection, treatment,
survivorship
Community resources for cancer patients & caregivers
Community physician information
Population based information
Population Based Information
Behavioral Risk Factor Data
Focus Group Data
Cancer Screening Behaviors:
• Colorectal Screening
• Breast and cervical screening
• Prostate Screening
Access to Care:
• Insurance
• Inability to see a physician
• Regular physician visits
General Population
 Local perception of health issues
 Attitudes and barriers to
preventive health behaviors
 Perceptions of cancer and clinical
trials
Cancer Survivors and
Caregivers
Experience in HD with diagnosis,
treatment, follow-up care
 Barriers to detection and
treatment
 Resources needs of community
 Clinical trials

Cancer Prevention Behaviors:
• Diet
• Physical exercise
• Weight
• Tobacco use
Total population = 104,000
7 counties :
all designated as medically underserved.
all designated as rural
(except Amelia County and parts of Cumberland County)
Demographic Profile of Piedmont Health District
Category
Gender
•High 65+ groupretirement area
Age
•32% black, 64% white
•Poverty:
•22.9% vs 7.2% state
•Unemployment:
•8.9% vs 6.5% state
Race
Ethnicity
Other
Factors
Subcategory
VIRGINIA
Male
Female
18-39
40-49
50-64
count
count
42,788
42,788
40,700
40,700
30,433
30,433
14,817
14,817
21,644
21,644
percent
51%
49%
36%
18%
26%
count
2,978,956
3,168,391
2,432,581
1,190,020
1,547,809
percent
48%
52%
40%
19%
25%
65+
16,594
16,594
20%
976,937
16%
White
53,337
53,337
64%
4,133,385
67%
Black or AA
AA
27,052
27,052
32%
1,135,015
18%
Other
Hispanic or
Latino
3,099
3,099
4%
878,947
14%
1,783
1,783
2%
426,857
7%
Non-Hispanic or
Latino
or
Latino
81,705
81,705
98%
5,720,490
93%
Poverty Status
Status
24,024
24,024
22.9%
1,967,020
7.2%
Unemployment
Unemployment
Rate
4,207
4,207
8.9%
276,350
6.5%
Median Income
level level
Income
$39,718
$39,718
Total
Total
Data source: 2010 Census Summary File 1 - (Virginia)
[machine-readable data files]/prepared by the U.S.
Census Bureau, 2011
PIEDMONT
PIEDMONT
83,488
83,488
$60,316
100%
6,147,347
•All population number are for ages 18+
•Poverty level uses total population of 104,609
•Unemployment rate uses the total population of employable citizens
100%
Demographic Profile of Piedmont Health District
PIEDMONT
Category
Gender
Age
Race
Ethnicity
Subcategory
Male
Female
18-39
40-49
50-64
65+
White
Black or AA
Other
Hispanic or Latino
Non-Hispanic or Latino
Total Population
VIRGINIA
count
percent
count
percent
42,788
40,700
30,433
14,817
21,644
16,594
53,337
27,052
3,099
1,783
81,705
51%
2,978,956
48%
49%
3,168,391
52%
36%
2,432,581
40%
18%
1,190,020
19%
26%
1,547,809
25%
20%
976,937
16%
64%
4,133,385
67%
32%
1,135,015
18%
4%
878,947
15%
2%
426,857
7%
98%
5,720,490
83,488
100%
93%
100%
6,147,347
Data source: 2010 Census Summary File 1 - (Virginia) [machine-readable data files]/prepared by the U.S. Census Bureau, 2011. All population numbers are for ages
18 and over.
Economic Characteristics of counties within Piedmont Health District
Location
% Less than
high school
school
% High
Education school or
3 (25 years GED
and older)
% Bachelor’s
Bachelor’s
degree or
above
Amelia
Buckingham
Charlotte
Cumberland
Lunenburg
Nottoway
Prince
Edward
Piedmont
(average)
Virginia
25.40%
36.80%
29.30%
28.30%
29.40%
27.80%
18.10%
27.87%
14.20%
41.10%
35.80%
34.50%
40.60%
39.10%
37.30%
44.70%
39.01%
26.30%
9.60%
12.60%
13.10%
10.50%
9.00%
12.10%
19.00%
12.27%
33.50%
In Buckingham, percentage of population with
less than high school education is greater
than 47.8% for the age group 18-24 years old.
US Census Burea, American Factfinder
Educational Attainment’ 2006-2010, 5 year
estimate
Age-Adjusted
Incidence
Rate
Site
– Piedmont
vs. Virginia
Age-Adjusted
Incidence
Rateby
by Cancer
Cancer Site
- Piedmont
vs. Virginia
Piedmont
182.9
168.1
Male Genital System*
152.6
155.2
Female Breast*
Average Annual Number of Cancer
Cases (1999-2008)
Cancer Site
Piedmont
91.3
84.0
GI
Cancer Site
Virginia
80.9
72.8
Respiratory
47.3
46.1
Gynecological*
34.2
32.9
Urinary System
29.6
34.3
Heme-malignancies
11.0
10.5
Oral Cavity, Pharynx
10.8
10.8
Brain, Nervous System, Eye
Male Genital System: includes
prostate and all other genital
cancers.
Gynecological: includes cervical,
ovarian, uterus NOS, and all other
gynecological cancers.
Heme-malignancies: includes
lymphomas, myelomas, leukemia.
Respiratory: includes
lung/bronchus, and other
respiratory cancers.
GI: includes colon/rectum and
other gastrointestinal cancers.
0
25
566
GI
107
Male Genital System*
97
Respiratory
95
Female Breast*
91
Urinary System
39
Heme-malignancies
33
Gynecological*
28
Oral Cavity, Pharynx
12
Brain, Nervous System, Eye
11
All Other Sites
46
486.9
485.6
All Sites
41.0
56.2
All Other Sites
All Sites
0
50
75
100
100
200
125
300
150
400
500
175
200
Age-adjusted Incidence Rate per 100,000 Population
* Rate for Male Genital System is shown per 100,000 males; Rates for Gynecological and Female Breast are shown per 100,000 females.
Data Source: Virginia Cancer Registry(averaged rates for1999-2008) – all rates calculated based on populations including all ages.
Age-Adjusted
Mortality
Rate
by by
Canceer
Site
– Piedmont
vs. Virginia
Age-Adjusted
Mortality
Rates
Cancer Site
- Piedmont
vs. Virginia
Piedmont
Respiratory
53.8
63.1
42.8
39.0
GI
Male Genital System*
Cancer Site
Virginia
Female Breast*
28.4
25.3
Cancer Site
All Sites
244
27.5
24.6
Respiratory
78
GI
53
Female Breast*
17
Heme-malignancies
15
Urinary System
14
Male Genital System*
14
Gynecological*
10
Brain, Nervous System, Eye
5
Oral Cavity Cancer
3
All Other Sites
35
15.3
13.5
Gynecological*
Male Genital System: includes
prostate and all other genital
cancers.
Gynecological: includes cervical,
ovarian, uterus NOS, and all other
gynecological cancers.
Heme-malignancies: includes
lymphomas, myelomas, leukemia.
Respiratory: includes
lung/bronchus, and other
respiratory cancers.
GI: includes colon/rectum and
other gastrointestinal cancers.
12.4
15.1
Heme-malignancies
11.4
8.3
Urinary System
4.5
3.9
Brain, Nervous System, Eye
Average Annual Number of Cancer
Deaths (2005-2009)
2.6
1.7
Oral Cavity Cancer
28.2
28.0
0
199.2
180.9
All Sites
All Other Sites
10
0
20
30
40
Piedmont
50
50
100
60
150
200
70
80
Age-adjusted Mortality Rate per 100,000 Population
* Rate for Male Genital System is shown per 100,000 males; Rates for Gynecological and Female Breast are shown per 100,000 females.
Data Source: Vital Statistics Department, VDH (averaged rates 2005-2009) – all rates calculated based on populations including all ages.
Table G – medical oncology admissions
Piedmont Resident Inpatient Medical Oncology Admissions
to hospitals within and outside of health district (CY2010)
Admitting Hospital
# of admissions
% of admissions
37
14.2%
$
526,209
37
14.2%
$
526,209
223
85.8%
$ 10,075,236
UNIVERSITY OF VIRGINIA MEDICAL CENTER
46
17.7%
$
2,642,416
CJW MEDICAL CENTER - CHIPPENHAM
46
17.7%
$
2,780,594
MEDICAL COLLEGE OF VIRGINIA
41
15.8%
$
2,311,778
CENTRA HEALTH, INC.
19
7.3%
$
430,600
BON SECOURS ST. FRANCIS MEDICAL CENTER
15
5.8%
$
447,378
HALIFAX REGIONAL HEALTH SYSTEM INC.
14
5.4%
$
265,591
COMMUNITY MEMORIAL HEALTHCENTER
13
5.0%
$
255,453
HENRICO DOCTORS' HOSPITAL - FOREST
11
4.2%
$
426,766
BON SECOURS ST. MARY'S HOSPITAL
8
3.1%
$
315,849
MARTHA JEFFERSON HOSPITAL
7
2.7%
$
113,754
SOUTHSIDE REGIONAL MEDICAL CENTER
2
0.8%
$
27,124
MEDICORP AT STAFFORD, LLC
1
0.4%
$
57,932
260
100.0%
Hospitals within patient health district
SOUTHSIDE COMMUNITY HOSPITAL INC.
Hospitals outside of patient health district
Grand Total
Charges
$ 10,601,445
Facility Survey Takeaways
Not Available

Imaging Services
•
•

Surgical Services
•
•
•

Radiation treatment
CT colonography
Breast reconstruction
GI-liver/pancreas
Lung
Counseling
Oncology certified dietician to provide nutritional counseling specific to cancer
patients
• Cancer patient navigator
•

Desired Programs
•
•
No established clinical trial programs
No Palliative Care programs
Physicians Survey Takeaways
Most common reasons patients choose not to have recommended
cancer screenings as identified by physicians
Lack of insurance
89%
Financial constraints
82%
Apprehension about the test
64%
Lack of transportation
50%
Afraid of being diagnosed with cancer
46%
Don't believe they are necessary
36%
Lack of screening facilities
14%
Too busy
11%
Other
7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of responding physicians *
_________________________________________________________________________________________________
* - Percentage is calculated based on the total number of responses for each reason selected out of the total number of physicians that completed the questionnaire and identified
their practice area as part of health district.
Physicians Survey Takeaways
Post-cancer treatment care topics on which physicians are interested to
receive more information
Pain Management
Surveillance of cancer recurrence
Long-term cancer treatment effects:
monitoring and palliation
Wellness and prevention of cancer recurrence
Genetic counselling for family members of
cancer patients
End-of-life care and planning
Less Interested

Interested
Highly Interested
Key Leader Physicians stated they are unsure of narcotic dosages and
uncomfortable with end of life drug issues.
Key leader and physician perspective

Lack of financial resources
 Uninsured/Underinsured
 Underutilization of EWL and other programs

Lack of integrated system between GP, oncologist,
HH and hospice

No Cancer Support Services
 No support groups
 Hospice underutilized

Lack of specialists
 MD recruitment issues
 Recent loss of multiple specialists
 Two oncologists part-time for the district

Education
 Knowledge deficit of MD’s r/t pain control for Hospice patients
 Inconsistencies on screening guidelines
Behavioral Risk Factor Surveillance System Analysis
Lifestyle
80
PIEDMONT
VA
70
Percent age (%)
60
50
40
69.6
61.4
30
20
32.0
10
22.4
24.7
26.7
23.0
18.4
23.6
24.3
0
No regular
exercise*
1
Vegetables are
part of daily diet
2
Obese
adults *
3
Current
Smokers
4
Data Source: BRFSS datasets – aggregated years 2006-2010.
* - indicates a significant statistical difference;
Former
Smokers
5
Behavioral Risk Factor Surveillance System Analysis
% of Adults With No Exercise in the past 30 days
70
- Black population less likely to exercise
- Low wage earners exercise less
- Less educated not likely to exercise
60
50
Percent age (%)
40
30
47.6
20
36.4
39.4
35.8
27.8
10
19.2
23.5
0
White
(ref)
Black
or AA *
Race/
Ethnicity
<$25K * $25K ≤ HI ≤
$50K
>$50K
(ref)
Household
Income
High
Some
School / College or
GED or less higher
*
(ref)
Education
* - indicates a significant statistical difference; (ref) - indicates reference group; & - indicates standard error > 5
Data Source: BRFSS datasets – aggregated years 2006-2010.
Racial category “All Other Races” not shown due to low sample number of survey respondents (n<20), weighted sample (<6000)
Racial category “White” includes white non-Hispanic population, racial category “Black or African American” includes black non-Hispanic population.
Behavioral Risk Factor Surveillance System Analysis
Health Care Access
25
PIEDMONT
Percentage (%)
20
VA
15
10
5
18.4
17.8
12.0
11.4
0
No health
insurance *…
Unable to see doctor
because of cost *…
Data Source: BRFSS datasets – aggregated years 2006-2010.
* - indicates a significant statistical difference
Behavioral Risk Factor Surveillance System Analysis
% Not Able To See Doctor Because of Cost in the Past Year
50
45
40
35
30
Percentage (%)
25
20
34.7
5.9
29.6
15
8.1
26.5
10
5
13.7
14.1
17.3
14.8
0
White Black
(ref) or AA *
Race/
Ethnicity
<$25K $25K ≤ >$50K
*
(ref)
HI ≤
$50K
Household Income
18-39 40-49
*
50-64
65+
(ref)
Age
* - indicates a significant statistical difference; (ref) - indicates reference group; & - indicates standard error > 5
Data Source: BRFSS datasets – aggregated years 2006-2010.
Racial category “All Other Races” not shown due to low sample number of survey respondents (n<20), weighted sample (<6000)
Racial category “White” includes white non-Hispanic population, racial category “Black or African American” includes black non-Hispanic population.
General Population Focus Groups Takeaways

Clinical Trials:
◦ “Pharmaceutical profit”

Logistics:
◦ “I have to go all the way to South Hill for a mammogram. Over an hour away!”

Financial:
◦ “Me, without insurance. I’m not going to get the treatment.”

Environmental:
◦ “They put up signs about a year ago not to drink the water at work.”
◦ “I had 9 people within a 3 mile radius of my home with cancer. 7 had breast CA.”

Lifestyle:
◦ “They make processed food look so much more appealing.”
◦ “Eating healthy is expensive.”
◦ “The community is not geared toward exercise.”
◦ “I’m 18 now. I’d say 80% of my friends smoke.”
Cancer Survivors Focus Groups Takeaways

Barriers to care:
◦ limited facilities
◦ travel logistics
◦ cost of treatment

Support Service:
◦
◦
◦
◦

“I needed more coordination of events. I was drowning.”
“I needed the facts.”
“I had to put my faith in God and the doctors.
“There is no support besides my family. Nothing, no one.”
Research:
◦ “It is happening somewhere, but I don’t know where it is.”
◦ “Someplace far away, Boston. New York, Mayo Clinic…”
Research / Intervention Needs

Resources:
◦
◦
◦
◦
◦

Environmental Issues:
◦
◦
◦
◦

Identification of hazards
Toxic waste
Aerial spraying
Bio-solids
Education:
◦
◦
◦
◦

Utilization of Programs (EWL)
Mental health support
Development of support groups
Mobilization of the Faith Community
Identifying/writing grants
Promotion of exercise
Promotion of healthy diets (Farmers markets)
Stop smoking campaign
Educational Programs targeting early development
MD Education:
◦ Clarification of screening guidelines
◦ Narcotic usage in hospice
◦ Local resources
Summation

District Task Force
◦ Incorporating the healthcare facilities and
organizations, local government, the school systems,
and the available expertise at VCU

Cancer Patient Navigator/Resource Center